Tumors in childhood and adolescence

Amplification behavior of one chromosome locus (D17S5), widely used in identification studies, is investigated. The effect of preferable amplification of alleles, characteristic of this locus, often leads to an erroneous conclusion about homozygosity. Our studies showed, that along with the hazard of typing false homozygotes in analysis of locus D17S5, more intricate cases with genotype distortion can occur in expert practice, which may be characterized not only by partial loss of the true alleles, but even by amplification of nonspecific (nonallele) fragments simulating the false-heterozygotic allele profile. Analysis of the stability of amplification profile helps solve this problem.     

Migraine in childhood and adolescence

A 62 years old man was admitted to hospital because of fever; a small superficial hepatic nodule was showed by ultrasonography. Blood cultures grew Salmonella enteritidis. Cefotaxime was administered for ten days. Fever promptly disappeared but one week later recurred with abdominal and back pain. Cultures grew again Salmonella enteritidis. Biopsy of the hepatic nodule showed hepatocarcinoma. Computed abdominal tomography showed a paraaortic mass. Angiography demonstrated hematoma communicating with the aortic lumen. The patient underwent revascularization of the involved aortic tract and resection of the hepatic nodule. Histology showed suppurative aortic endarteritis and a well-differentiated hepatocellular carcinoma with a large area of suppurative necrosis. The recovery of Salmonella species as of any uncommon bacteria from blood should warrant a through research of underlying disease, especially cancer.     

Nasopharyngeal carcinoma in childhood and adolescence

BACKGROUND: This study reviews the authors' experience from 1979 through 1996 in the management and outcome of 56 patients with nasopharyngeal carcinoma who were under 20 years of age. PROCEDURE: There were 33 males and 23 females, their ages ranging from 7 to 19 years (median: 16 years). Forty patients had World Health Organization type III carcinomas, 16 had T4 tumors, 41 had metastatic cervical lymph nodes, and 50 were at stage III or stage IV. Thirty-two patients were treated with radiation therapy alone and 24 with the addition of chemotherapy. Cumulative radiation dose to the primary tumor ranged from 18 to 70 Gy (median: 66 Gy) and radiation dose to metastatic cervical lymph nodes ranged from 18 to 70 Gy (median: 66 Gy). RESULTS: Follow-up ranged from 0.1 to 16.8 years (mean: 9 years). Locoregional tumoral complete response was achieved in 49 patients. Locoregional tumoral failure was observed in 12 patients and systemic failure in 11. Overall, locoregional failure-free, metastases-free, and disease-free survival rates at 5 years were 49%, 62%, 79%, and 47%, respectively, for the entire group of patients, 42%, 61%, 72%, and 42%, respectively, for patients treated with radiation therapy alone, and 58%, 63%, 87%, and 54%, respectively, for patients treated with the addition of chemotherapy. Advanced T-stage and lower radiation doses worsened locoregional failure-free survival, whereas advanced N-stage and exclusion of chemotherapy worsened metastases-free survival. CONCLUSIONS: In children and adolescents with nasopharyngeal carcinoma, radiation therapy alone results in an improved locoregional tumoral response rate and a reduced locoregional tumoral failure rate at higher radiation doses, while the addition of chemotherapy results in a reduced systemic failure rate.     

Transcranial revascularisation in childhood and adolescence

Fifteen patients under the age of 20 years underwent transcranial revascularisation surgery: 13 presented with acute strokes or recurrent transient neurological events, one with progressive dementia and one with recurrent syncope. Five underwent unilateral and seven bilateral anastomosis of the superficial temporal artery to a branch of the middle cerebral artery (STA-MCA bypass). One patient aged 22 months underwent bilateral encephaloduroarterisynangiosis (EDAS). Three patients deteriorated postoperatively: one died from a probable cardiac cause, one had subarachnoid haemorrhage and the patient who underwent EDAS suffered further permanent ischaemic damage. No further permanent ischaemic events occurred following STA-MCA bypass (median follow-up 41 months). Transient ischaemic events persisted postoperatively in four cases, but with reduced severity. The results suggest that STA-MCA bypass may be effective in protecting young patients from further permanent ischaemic events in the treated vascular territory.     

Hemifacial spasm in childhood and adolescence

Hemifacial spasm (HFS), a hyperactive dysfunction of the facial nerve, is rarely seen in young people. Between 1984 and 1994, we treated 924 patients with HFS by microvascular decompression at our institution. Of these, 8 (0.9%) were younger than 30 years. In most of the older patients with HFS, the offending artery which compresses the root exit zone was elongated, redundant, and focally arteriosclerotic as a result of hemodynamic effects due to aging or hypertension. On the other hand, the offending artery did not exhibit such characteristic changes of the vasculature in children and adolescents with HFS. In all of the young patients who underwent initial microvascular decompression at our clinic, the arachnoid membrane around the facial nerve was thickened and encased the artery, resulting in compression of the root exit zone of the facial nerve. Such thickening of the arachnoid surrounding the offending vessel may play an important role in the pathogenesis of HFS by trapping and encasing the artery to compress the root exit zone, particularly in the young patients.     

Treatment of schizophrenia in childhood and adolescence

This paper reviews the management of schizophrenia occurring during childhood and adolescence. It considers the clinical features of the disorder particular to its early onset before providing a practical framework for assessment and treatment based upon a critical review of the available literature. A multi-modal approach to treatment encompassing the individual and their family is adopted with the roles of pharmacological, psychological, and environmental interventions all considered. The place of the newer "atypical" antipsychotic agents and the likelihood that they will soon become the first-line drugs of choice is particularly discussed.     

Axillary plexus catheter block in childhood and adolescence

During the past two years (1994 and 1995), eight patients with the average age of eleven and a half years (four to fifteen years) received continuous axillary plexus anaesthesia subsequent to severe injuries of their upper extremities. The advantage of intra-, peri-, and postoperative anaesthesia and postoperative pain management are presented as a case report.     

Automatic prejudice in childhood and early adolescence.

Four cross-sectional studies are presented that investigated the automatic activation of prejudice in children and adolescents (aged 9 years to 15 years). Therefore, 4 different versions of the affective priming task were used, with pictures of ingroup and outgroup members being presented as prejudice-related prime stimuli. In all 4 studies, a pattern occurred that suggests a linear developmental increase of automatic prejudice with significant effects of outgroup negativity appearing only around the ages of 12 to 13 years. Results of younger children, on the contrary, did not indicate any effect of automatic prejudice activation. In contrast, prejudice effects in an Implicit Association Test (IAT) showed high levels of prejudice independent of age (Study 3). Results of Study 4 suggest that these age differences are due to age-related differences in spontaneous categorization processes. Introducing a forced-categorization into the affective priming procedure produced a pattern of results equivalent to that obtained with the IAT. These results suggest that although children are assumed to acquire prejudice at much younger ages, automatization of such attitudes might be related to developmental processes in early adolescence. We discuss possible theoretical implications of these results for a developmental theory of prejudice representation and automatization during childhood and adolescence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Long-term outcome of migration in childhood and adolescence

Self-injurious behavior occurring in persons with severe mental retardation is a clinically significant and poorly understood problem. Multiple neurotransmitter systems have been implicated in the pathogenesis of this behavior, particularly dopaminergic, opioidergic, and serotonergic systems. Pemoline, a central stimulant, administered systemically at high doses reliably produces self-biting behavior in the rat. The systemic bolus of pemoline produces sustained neostriatal levels of pemoline for over 24 h in a continuous infusion paradigm. Studies of the effect of cortical lesions on pemoline-mediated behaviors reveal that cortical damage, as is common in profound mental retardation, lowers the threshold for pemoline-induced self-biting behavior. Data from the corticostriatal slice suggests that sustained exposure to pemoline produces a shift in N-methyl-D-aspartate receptor-mediated responses rendering them more susceptible to dopaminergic enhancement. Thus, dopaminergic and glutamatergic interactions appear to play an important role in the development and expression of self-biting in the pemoline model.     

Sport psychiatry in childhood and adolescence: an overview

This review explores the importance and relevance of sport during childhood and adolescence, utilizing traditional stage theories of development. The literature supports the notion that sport is a necessary study as a health issue and a preventative tool in the field of psychiatry. Play and sport in childhood and adolescence enhance development physically, mentally, and socially. Participating in athletics encourages the development of leadership skills, self-esteem, muscle development and overall physical health. There is a lack of literature in the important area of sport psychiatry especially when considering beneficial, not deficit oriented youth athletic development. Child psychiatrists need to begin researching sport in order to develop a comprehensive understanding of how athletics can enhance the mental and physical health of youth.     

Suprasellar germinomas in childhood and adolescence: diagnostic pitfalls

STUDY OBJECTIVE: To compare the adequacy and efficacy of anesthesia experienced with lidocaine-epinephrine-tetracaine (LET) solution versus LET gel during suturing of uncomplicated lacerations on the face or scalp in children. METHODS: Two hundred children with lacerations of the face and scalp requiring suturing were enrolled in this blinded, randomized controlled trial, in the emergency department of a university-affiliated children's hospital. After the application of anesthetic solution or gel, adequacy of anesthesia was determined before suturing. Efficacy of anesthesia during laceration repair was determined by the length of time after removal of the topical anesthetic to the first sign of discomfort that required additional anesthesia or until suture completion. RESULTS: Adequacy of initial anesthesia was equivalent between LET solution and LET gel. There was a significant difference in efficacy of anesthesia between the LET formulations. There were more patients with complete anesthesia (85% versus 76%), fewer persons with partial anesthesia (5% versus 21%), and more persons with incomplete anesthesia (9% versus 3%) in the gel group. CONCLUSION: LET gel is at least as effective as LET solution and possesses theoretical advantages for topical anesthesia during suturing of uncomplicated lacerations on the face and scalp in children.     

Changes in migraine symptoms from childhood to adolescence

INTRODUCTION: Kaposi's disease is increasingly frequent in transplant recipients. The therapeutic approach in heart transplantation is not fully established. CASE REPORT: A 61-year-old male transplant recipient (June 1992) presented Kaposi's disease on the legs. Immunosuppressive therapy was reduced, cyclosporin by 20 p. 100, withdrawal of azathioprine and 40 p. 100 reduction in prednisone was insufficient to control the disease. Due to the extension of the lesions and the major functional handicap, bleomycin was given and led to complete regression of the lesions within 6 months. DISCUSSION: This case illustrates the difficult therapeutic situation encountered in heart transplant recipients. The situation may be life-threatening with organ rejection. The first step is to reduce immunosuppressive therapy. If this is insufficient or the Kaposi is particularly aggressive, bleomycin may be used. The efficacy of bleomycin observed in our case requires confirmation in multicenter studies.     

Coping with stress during childhood and adolescence.

In this article, research on how children and adolescents cope with stress and coping's role in reducing the adverse psychological states associated with stress is reviewed. Child and adolescent coping is reflected in seven different lines of research—infants' responses to maternal separation, social support, interpersonal cognitive problem-solving, coping in achievement contexts, Type A behavior pattern in children, repression–sensitization, and resilience to stress. A variety of different coping resources, styles, and specific strategies are important in successfully adapting to stress, including efforts that focus directly on the problem, as well as attempts to deal with adverse emotions associated with stress. Directions for future research are identified, emphasizing the need for more systematic comparisons of coping across different types of stress and over time in response to a single stressful episode. (PsycINFO Database Record (c) 2010 APA, all rights reserved)